MEDICARE: REISS PSYCHOLOGY SERVICES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	36332	TX
2	103TC2200X	Clinical Child & Adolescent Psychologist	36332	TX
3	103TF0000X	Family Psychologist	36332	TX
4	103TC0700X	Clinical Psychologist	36332	TX

General Provider Information

NPI Number	:	1992258552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REISS PSYCHOLOGY SERVICES

Provider Business Mailing Address
First Line	:	13101 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5237
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	13101 PRESTON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75240-5237
Country	:	US
Telephone Number	:	469-247-5445
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	EMILY REISS
Credential	:	PSYD
Telephone Number	:	469-247-9656

Provider Enumeration Date	:	08/01/2016
Last Update Date	:	08/01/2016

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